Double-Level Osteotomy in Severe Varus Malalignment to Optimize Knee Joint Restoration

Area of Science:

• Orthopedic Surgery
• Biomechanical Engineering

Background:

• Lower extremity alignment correction for unicompartmental osteoarthritis is increasingly common.
• Medial open-wedge high tibial osteotomy (MOW-HTO) is the primary technique but has limitations in severe malalignment cases.
• Double-level osteotomy may be necessary for significant deformities.

Purpose of the Study:

• To describe the indications and technique for double-level osteotomy in correcting lower extremity malalignment.
• To evaluate the efficacy and potential benefits of double-level osteotomy compared to single-level procedures.

Main Methods:

• Detailed analysis of malalignment using full-leg radiographs (hip-knee-angle, mMPTA, mLDFA, JLCA).
• Preoperative planning including arthroscopy to assess cartilage and intraarticular pathologies.
• Sequential femoral supracondylar (closed wedge, biplanar) and tibial (open wedge, biplanar) osteotomies with angle-stable plate fixation.
• Use of resected bone wedge for tibial osteotomy bone stock.

Main Results:

• Recent literature shows promising results for double-level osteotomies in correcting severe varus deformities.
• Studies report significant improvements in patient-reported outcomes and good clinical results.
• Splitting corrections into two smaller osteotomies may reduce complications like hinge fracture and delayed healing.

Conclusions:

• Double-level osteotomy is indicated for severe lower extremity malalignment when MOW-HTO alone is insufficient.
• Accurate preoperative planning is essential for successful surgical outcomes.
• This technique offers a viable solution for complex cases, potentially lowering complication rates.